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Ce présent article porte sur la typologie structuro-fonctionnelle des systèmes de production à base d’igname. Les données de terrain ont été collectées auprès de trente-huit 38 producteurs d’igname dans la commune de Léo, à l’aide de guide d’entretien. L’analyse des données dévoile trois archétypes par niveaux de prospérité et cinq stratégies agricoles. Des producteurs de niveaux de prospérité différents se rencontrent dans des types fonctionnels identiques. Les ressources mobilisées sont d’origine endogènes et locales ; de sources multiples ou externes. La typologie est corrélée à la capacité de diversification des activités, d’intensification du capital social et de créativité de marge de manœuvre. L’étude se fonde sur les théories de l’action et de la représentation sociale.

The deep geological repository for radioactive waste in Switzerland will be embedded in an approximately 100 m thick layer of Opalinus Clay. The emplacement drifts for high-level waste (approximately 3.5 m diameter) are planned to be excavated with a shielded tunnel boring machine (TBM) and supported by a segmental lining. At the repository depth of 900 m in the designated siting region Nördlich Lägern, squeezing conditions may be encountered due to the rock strength and the high hydrostatic pressure (90 bar). This paper presents a detailed assessment of the shield jamming and lining overstressing hazards, considering a stiff lining (resistance principle) and a deformable lining (yielding principle), and proposes conceptual design solutions. The assessment is based on three-dimensional transient hydromechanical simulations, which additionally consider the effects of ground anisotropy and the desaturation that may occur under negative pore pressures generated during the drift excavation. By addressing these design issues, the paper takes the opportunity to analyse some more fundamental aspects related to the influences of anisotropy and desaturation on the development of rock convergences and pressures over time, and their markedly different effects on the two lining systems. The results demonstrate that, regardless of these effects, shield jamming can be avoided with a moderate TBM overcut, however overstressing of a stiff lining may be critical depending on whether the ground desaturates. This uncertainty is eliminated using a deformable system with reasonable dimensions of yielding elements, which can also accommodate thermal strains generated due to the high temperature of the disposal canisters.

BackgroundGrowing concerns about mosquito-borne diseases (MBDs) in urban settings have prompted renewed urgency for collaborative and active mosquito surveillance programs. This literature review collates entomological data from five East African Community (EAC) countries, studying the definitions of urban settings, co-occurrence of Anopheles, Aedes and Culex mosquito genera and their infection rates to provide a wholistic understanding of MBDs in urban EAC.MethodsA literature search following the PRISMA-ScR guidelines was conducted in EMBASE, MEDLINE, PubMed, Web of Science and Scopus databases to identify entomological studies conducted in urban and peri-urban settings since 2000. Data on urban and peri-urban settings definitions, presence records and infection rates of Aedes, Culex and Anopheles mosquitoes were compiled and presented.ResultsA hundred and five articles were included in the review. Diverse definitions of urban landscapes emerged, emphasizing (i) distinct characteristics for dichotomous delineation from rural settings (e.g., population density) and (ii) urban-peri-urban continuum integrating spatial variations in urban features associated with MBDs (e.g., planned/unplanned neighbourhoods). Mosquito ecology data derived from 88 sites, comprising 45 urban, 25 peri-urban, 14 mixed settings and four slums, reported 91 mosquito species, including 32% Culex, 31% Aedes, and 25% Anopheles genera. Other co-occurring genera, such as Coquillettidia and Mansonia, represented 12% between 2000 and 2024. Intricate co-occurrence patterns among Aedes, Culex and Anopheles genera linked to habitat preference and climatic conditions (temperature and precipitation) were observed. The average infection rates were estimated as 0.8% for yellow fever, 0.9% and 1.1% for urban and peri-urban P. falciparum sporozoites respectfully, 2.7% for Dengue, 5.3% for Chikungunya and 6.02% for flavivirus, indicating co-circulation of arboviruses among mosquito population.ConclusionOur synthesis presents an overview of the complexities of urban MBD research over the past two decades. Integrated assessment of MBDs dynamics in rapidly evolving urban environments is crucial to achieving healthier urban environments in East Africa.Systematic review registrationhttps://osf.io/a6s9j/.

Objetivo: As leucemias e os linfomas não hodgkins juntos ocupam a 4ª posição entre as neoplasias hematológicas. Essas doenças possuem opções de tratamento curativo mesmo em situações adversas, contudo o processo de tomada de decisão é delicado, sendo a utilização dos modelos estatísticos capazes de ajudar na tomada de decisão. Aqui avaliamos quais são as escalas de toxicidade à quimioterapia e seu papel na tomada de decisão para o tratamento de pacientes com linfomas e leucemias agudas. Metodologia: A partir da abordagem do protocolo PRISMA, foi realizado uma revisão de escopo nas plataformas PUBMED, BIREME, COCHRANE e Periódicos da CAPES, utilizando a equação de busca: (“acute leukemia” or “acute leukaemia” or “acute myeloid leukemia” or “acute myeloid leukaemia” or “acute lymphoid leukemia” or “acute lymphoid leukaemia” or lymphoma) and (scale or score or index) and (“decision making” or “decision support techniques” or “clinical decision-making” or “clinical decision” or “decision trees” or “decision support systems, clinical” or “therapeutic decision”) and (chemotherapy or treatment or therapy) and (toxicity or mortality or “tolerability” or “risk-directed therapy” or “risk-directed treatment” or “risk-directed chemotherapy” or “therapy related risk” or “treatment related risk” or “chemotherapy related risk”). Nesta revisão incluíram-se artigos que tivessem discussão focada na análise de modelos estatísticos, para tomada de decisão terapêutica, em relação ao uso de quimioterapia nos pacientes com linfomas ou nas leucemias agudas. Não foi estabelecido corte temporal da publicação ou língua para a inclusão nesta revisão. Resultados: Após excluídas as duplicatas foram encontrados 402 artigos nas plataformas de pesquisa, seguindo o protocolo PRISMA foram selecionados 30 artigos. A partir deles foi observado que não existe uma única escala ideal para avaliação de toxicidade à quimioterapia, mas existem escalas estudadas para alguns grupos específicos que possuem variáveis comuns como as comorbidades, a funcionalidade, a idade, o LDH, a função renal e o estadiamento da doença. Ao analisar as conclusões de cada estudo observou-se que os vários modelos estatísticos analisados têm grande potencial em discriminar principalmente, a população de baixo risco para realização de tratamento com quimioterapia e que o potencial do uso desses modelos, na tomada de decisão, precisa ser mais bem analisado por estudos mais amplos, prospectivos e capazes de validar essas estratégias. Além disso, foi possível perceber que a variável idade, isoladamente, não foi um preditor suficientemente confiável para uma tomada de decisão, em relação ao tratamento. As variáveis comorbidade e funcionalidade foram apontadas como principais indicadores, em relação aos riscos de realização da quimioterapia. Conclusão: Os modelos preditores de toxicidade ao tratamento em pacientes com leucemias agudas e linfomas necessitam de estudos mais robustos e prospectivos que incluam validação desses modelos para sua melhor aplicabilidade.

Objetivos: A transfusão de hemocomponentes é um procedimento com riscos significativos, motivo pelo qual a Organização Mundial da Saúde incentiva o desenvolvimento de programas para o manejo adequado dos hemocomponentes por meio de estratégias de Patient Blood Management, otimizando o uso destes produtos. Nesse contexto, a agência transfusional do Hospital Regional do Sertão Central (HRSC) coleta informações e gera indicadores para avaliar o nível de adesão ao seu protocolo de segurança. Este estudo teve como objetivo descrever o perfil das transfusões realizadas no HRSC no ano de 2022 no setor de clínica médica e na unidade de terapia intensiva (UTI). Metodologia: Foram coletados dados de transfusões em adultos por meio do registro de indicadores de qualidade da agência transfusional do HRSC e, posteriormente, foi realizada uma análise retrospectiva, descritiva e quantitativa. Resultados: Este estudo analisou 1072 transfusões, sendo que 53,3% ocorreram em homens e 46,7% em mulheres, com média de idade de 42 anos. A UTI solicitou 79,1% das transfusões. As principais causas foram a anemia sintomática e o sangramento. Os concentrados de hemácias (73%) foram os mais solicitados, sendo 49,6% de O+. Em termos de criticidade, 54% dos pedidos eram urgentes. Entre as transfusões avaliadas foram observadas 16 notificações de reações adversas. Conclusões: A análise das transfusões permitiu identificar e descrever as características da condução do processo de transfusões em um hospital de referência terciária de uma cidade do interior do Ceará. O levantamento de dados mostrou que a equipe manteve bons níveis de adesão ao protocolo de indicação transfusional, mas com possível subnotificação de reações transfusionais.

Objectives: This study examines long COVID symptoms course over 12 months, their impact on daily life, and associated factors for symptom relief. Methods: A prospective cohort study included 231 participants with long COVID at 12-month follow-up. Data on characteristics, symptom course, and remission were collected using a questionnaire and a remission scale. Poisson regression models were used to estimate the prevalence rate ratio (PRR) and 95% confidence intervals (CIs) for factors associated with symptom improvement. Results: Of the 231 participants, 63.2% developed SARS-CoV-2 antibodies before COVID-19 vaccination. At 12 months, only 8.7% (95% CI: 5.4-13.1%) reported complete remission, while 28.6% noted significant improvement. Most symptoms remained prevalent: asthenia (83.1%), neurocognitive/neurological (93.9%), cardiothoracic (77.9%), Musculoskeletal (78.8%). During long COVID, 62.2% stopped working, and only 32.5% resumed full-time professional activities. Presence of SARS-CoV-2 antibodies before vaccination increased the probability of improvement (aPRR: 1.60, P = 0.028), while ageusia at initial long COVID phase decreased the probability (aPRR: 0.38, P = 0.007). Conclusions: Long-COVID symptoms persisted in the majority of participants after 12 months, with significant impacts on daily life and work. SARS-CoV-2 antibodies were associated with better prognosis, while persistent ageusia indicated a lower probability of improvement. These findings highlight the need for ongoing support and care for individuals with long COVID.

Abstract Most established clinical walking tests assess specific aspects of movement function (velocity, endurance, etc.) but are generally unable to determine specific biomechanical or neurological deficits that limit an individual’s ability to walk. Recently, inertial measurement units (IMU) have been used to collect objective kinematic data for gait analysis and could be a valuable extension for clinical assessments (e.g., functional walking measures). This study assesses the reliability of an IMU-based overground gait analysis during the 2-min walk test (2mWT) in individuals with spinal cord injury (SCI). Furthermore, the study elaborates on the capability of IMUs to distinguish between different gait characteristics in individuals with SCI. Twenty-six individuals (aged 22–79) with acute or chronic SCI (AIS: C and D) completed the 2mWT with IMUs attached above each ankle on 2 test days, separated by 1 to 7 days. The IMU-based gait analysis showed good to excellent test–retest reliability (ICC: 0.77–0.99) for all gait parameters. Gait profiles remained stable between two measurements. Sensor-based gait profiling was able to reveal patient-specific gait impairments even in individuals with the same walking performance in the 2mWT. IMUs are a valuable add-on to clinical gait assessments and deliver reliable information on detailed gait pathologies in individuals with SCI. Trial registration: NCT04555759.

Este artigo analisa os fatores políticos e históricos que levaram ao aumento da importância do rateio da cota parte municipal do ICMS vinculado a indicadores educacionais no estado do Ceará. Caracteriza-se como um estudo qualitativo, de natureza descritiva e explicativa, examinando o processo de municipalização do Ensino Fundamental e a colaboração entre o governo estadual e os municípios, além de investigar as mudanças no ordenamento jurídico relacionadas à parte discricionária do ICMS, que é atribuída ao poder executivo estadual. Considerando as mudanças nas políticas educacionais nesse estado, as quais passaram a ser acompanhadas por uma gestão voltada para resultados e responsabilização com base em avaliações em larga escala, conclui-se que as mudanças no rateio da cota parte do ICMS se beneficiaram das condições específicas dessa unidade da federação. Destacam-se as características que possibilitam uma forte influência sobre os municípios em razão do poder de barganha estadual.

Brown-Séquard Syndrome (BSS) is a rare neurological condition caused by a unilateral spinal cord injury (SCI). Upon initial ipsilesional hemiplegia, patients with BSS typically show substantial functional recovery over time. Preclinical studies on experimental BSS demonstrated that spontaneous neuroplasticity in descending motor systems is a key mechanism promoting functional recovery. The reticulospinal (RS) system is one of the main descending motor systems showing a remarkably high ability for neuroplastic adaptations after incomplete SCI. In humans, little is known about the contribution of RS plasticity to functional restoration after SCI. Here, we investigated RS motor drive to different muscles in a subject with Brown-Séquard-plus Syndrome (BSPS) five months post-injury using the StartReact paradigm. RS drive was compared between ipsi- and contralesional muscles, and associated with measures of functional recovery. Additionally, corticospinal (CS) drive was investigated using transcranial magnetic stimulation (TMS) in a subset of muscles. The biceps brachii showed a substantial enhancement of RS drive on the ipsi- vs. contralesional side, whereas no signs of CS plasticity were found ipsilesionally. This finding implies that motor recovery of ipsilesional elbow flexion is primarily driven by the RS system. Results were inversed for the ipsilesional tibialis anterior, where RS drive was not augmented, but motor-evoked potentials recovered over six months post-injury, suggesting that CS plasticity contributed to improvements in ankle dorsiflexion. Our findings indicate that the role of RS and CS plasticity in motor recovery differs between muscles, with CS plasticity being essential for the restoration of distal extremity motor function, and RS plasticity being important for the functional recovery of proximal flexor muscles after SCI in humans.

The importance of eosinophilic granulocytes in cancer has been widely discussed in recent years. The current study reviews the evidence on the role of eosinophilic granulocytes in melanoma as a prognostic marker for cancer progression and the efficacy of treatment with modern immune checkpoint inhibitors. A total of 33 human clinical studies were included in the review, with heterogeneous data due to differences in patients populations, study design and inclusion of small study groups. However, 28 of the 33 studies suggested that eosinophilic granulocytes could be used as a prognostic biomarker for outcome and/or potential response to systemic treatment and/or occurrence of adverse events in melanoma patients. Nevertheless, the exact role of eosinophils remains to be elucidated. Further prospective, larger and better controlled studies are warranted to clarify the significance of eosinophilic granulocytes in patients with melanoma, in more details.

Valganciclovir (VGC) is administered as prophylaxis to kidney transplant recipients (KTR) CMV donor (D)+/recipient (R)− and CMV R+ after thymoglobulin-induction (R+/TG). Although VGC dose adjustments based on renal function are recommended, there is paucity of real-life data on VGC dosing and associations with clinical outcomes. This is a retrospective Swiss Transplant Cohort Study-embedded observational study, including all adult D+/R− and R+/TG KTR between 2010 and 2020, who received prophylaxis with VGC. The primary objective was to describe the proportion of inappropriately (under- or over-) dosed VGC week-entries. Secondary objectives included breakthrough clinically significant CMV infection (csCMVi) and potential associations between breakthrough-csCMVi and cytopenias with VGC dosing. Among 178 KTR, 131 (73.6%) patients had ≥2 week-entries for the longitudinal data of interest and were included in the outcome analysis, with 1,032 VGC dose week-entries. Overall, 460/1,032 (44.6%) were appropriately dosed, while 234/1,032 (22.7%) and 338/1,032 (32.8%) were under- and over-dosed, respectively. Nineteen (14.5%) patients had a breakthrough-csCMVi, without any associations identified with VCG dosing (p = 0.44). Unlike other cytopenias, a significant association between VGC overdosing and lymphopenia (OR 5.27, 95% CI 1.71–16.22, p = 0.004) was shown. VGC prophylaxis in KTR is frequently inappropriately dosed, albeit without meaningful clinical associations, neither in terms of efficacy nor safety.

Abstract Background Stromal vascular fraction (SVF) treatment promoted the regeneration of the intestinal epithelium, limiting lethality in a mouse model of radiation-induced gastrointestinal syndrome (GIS). The SVF has a heterogeneous cell composition; the effects between SVF and the host intestinal immunity are still unknown. The specific role of the different cells contained in the SVF needs to be clarified. Monocytes–macrophages have a crucial role in repair and monocyte recruitment and activation are orchestrated by the chemokine receptors CX3CR1 and CCR2. Methods Mice exposed to abdominal radiation (18 Gy) received a single intravenous injection of SVF (2.5 × 106 cells), obtained by enzymatic digestion of inguinal fat tissue, on the day of irradiation. Intestinal immunity and regeneration were evaluated by flow cytometry, RT-PCR and histological analyses. Results Using flow cytometry, we showed that SVF treatment modulated intestinal monocyte differentiation at 7 days post-irradiation by very early increasing the CD11b+Ly6C+CCR2+ population in the intestine ileal mucosa and accelerating the phenotype modification to acquire CX3CR1 in order to finally restore the F4/80+CX3CR1+ macrophage population. In CX3CR1-depleted mice, SVF treatment fails to mature the Ly6C−MCHII+CX3CR1+ population, leading to a macrophage population deficit associated with proinflammatory environment maintenance and defective intestinal repair; this impaired SVF efficiency on survival. Consistent with a CD11b+ being involved in SVF-induced intestinal repair, we showed that SVF-depleted CD11b+ treatment impaired F4/80+CX3CR1+macrophage pool restoration and caused loss of anti-inflammatory properties, abrogating stem cell compartment repair and survival. Conclusions These data showed that SVF treatment mitigates the GIS-involving immunomodulatory effect. Cooperation between the monocyte in SVF and the host monocyte defining the therapeutic properties of the SVF is necessary to guarantee the effective action of the SVF on the GIS.

Abstract Background Human multilineage-differentiating stress enduring (Muse) cells are nontumorigenic endogenous pluripotent-like stem cells that can be easily obtained from various adult or fetal tissues. Regenerative effects of Muse cells have been shown in some disease models. Muse cells specifically home in damaged tissues where they exert pleiotropic effects. Exposition of the small intestine to high doses of irradiation (IR) delivered after radiotherapy or nuclear accident results in a lethal gastrointestinal syndrome (GIS) characterized by acute loss of intestinal stem cells, impaired epithelial regeneration and subsequent loss of the mucosal barrier resulting in sepsis and death. To date, there is no effective medical treatment for GIS. Here, we investigate whether Muse cells can prevent lethal GIS and study how they act on intestinal stem cell microenvironment to promote intestinal regeneration. Methods Human Muse cells from Wharton’s jelly matrix of umbilical cord (WJ-Muse) were sorted by flow cytometry using the SSEA-3 marker, characterized and compared to bone-marrow derived Muse cells (BM-Muse). Under gas anesthesia, GIS mice were treated or not through an intravenous retro-orbital injection of 50,000 WJ-Muse, freshly isolated or cryopreserved, shortly after an 18 Gy-abdominal IR. No immunosuppressant was delivered to the mice. Mice were euthanized either 24 h post-IR to assess early small intestine tissue response, or 7 days post-IR to assess any regenerative response. Mouse survival, histological stainings, apoptosis and cell proliferation were studied and measurement of cytokines, recruitment of immune cells and barrier functional assay were performed. Results Injection of WJ-Muse shortly after abdominal IR highly improved mouse survival as a result of a rapid regeneration of intestinal epithelium with the rescue of the impaired epithelial barrier. In small intestine of Muse-treated mice, an early enhanced secretion of IL-6 and MCP-1 cytokines was observed associated with (1) recruitment of monocytes/M2-like macrophages and (2) proliferation of Paneth cells through activation of the IL-6/Stat3 pathway. Conclusion Our findings indicate that a single injection of a small quantity of WJ-Muse may be a new and easy therapeutic strategy for treating lethal GIS.

BackgroundEnterobacterales are often responsible for urinary tract infection (UTI) in kidney transplant recipients. Among these, Escherichia coli or Klebsiella species producing extended-spectrum beta-lactamase (ESBL) are emerging. However, there are only scarce data on frequency and impact of ESBL-UTI on transplant outcomes.MethodsWe investigated frequency and impact of first-year UTI events with ESBL Escherichia coli and/or Klebsiella species in a prospective multicenter cohort consisting of 1,482 kidney transplants performed between 2012 and 2017, focusing only on 389 kidney transplants having at least one UTI with Escherichia coli and/or Klebsiella species. The cohort had a median follow-up of four years.ResultsIn total, 139/825 (17%) first-year UTI events in 69/389 (18%) transplant recipients were caused by ESBL-producing strains. Both UTI phenotypes and proportion among all UTI events over time were not different compared with UTI caused by non-ESBL-producing strains. However, hospitalizations in UTI with ESBL-producing strains were more often observed (39% versus 26%, p = 0.04). Transplant recipients with first-year UTI events with an ESBL-producing strain had more frequently recurrent UTI (33% versus 18%, p = 0.02) but there was no significant difference in one-year kidney function as well as longer-term graft and patient survival between patients with and without ESBL-UTI.ConclusionFirst-year UTI events with ESBL-producing Escherichia coli and/or Klebsiella species are associated with a higher need for hospitalization but do neither impact allograft function nor allograft and patient survival.